Graft-Versus-Host Disease

Graft-versus-host disease (GVHD) is a potentially fatal complication and is one of the most common causes of nonrelapse mortality after allogeneic hematopoietic cell transplantation. Some of the factors that determine the risk of GVHD include the degree of human leukocyte antigen matching, donor type, graft source, gender disparity, conditioning intensity, and the type of GVHD prophylaxis. GVHD comprises two distinct entities categorized as acute or chronic depending on specific manifestations. Common organs involved by acute GVHD are skin, gastrointestinal tract, and liver, and is characterized by skin rash, nausea, vomiting, secretory diarrhea, and cholestatic liver dysfunction. Chronic GVHD can affect virtually any organ, with the most common being eyes, mouth, skin, joint/fascia, gastrointestinal tract, liver, lungs, and genitalia. In this chapter, we discuss the epidemiology, risk factors, pathophysiology, various classification systems used for staging and grading, and clinical manifestations of acute and chronic GVHD. We then elaborate on GVHD prevention strategies and briefly describe the treatment of GVHD. Finally, we touch on novel approaches to prevent or treat GVHD and future directions.